| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $21 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $14 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $9 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $59 | $194 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $267 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $18 | $60 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $12 | $17 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $18 | $57 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $28 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $35 | $113 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $70 | $94 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $141 | $205 | $258 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $14 | $91 | $169 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $95 | $136 | $177 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $7 | $95 | $184 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $81 | $123 | $207 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $12 | $81 | $150 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $14 | $97 | $182 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $10 | $103 | $195 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $12 | $73 | $152 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $6 | $84 | $162 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $6 | $76 | $161 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $14 | $95 | $177 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $10 | $95 | $181 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $113 | $148 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $81 | $134 | $208 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $31 | $58 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $20 | $140 | $260 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $23 | $209 | $487 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $117 | $205 | $294 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $109 | $138 | $194 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $109 | $161 | $263 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $117 | $179 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $106 | $155 | $205 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $21 | $220 | $419 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $59 | $225 | $390 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $169 | $339 | $510 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $275 | $355 | $434 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,159 | $1,218 | $1,276 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $107 | $142 |
| Spirometry CPT 94010 • Pulmonology | $5 | $24 | $42 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $20 | $46 | $73 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $63 | $78 | $93 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $21 | $25 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $44 | $95 | $147 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $29 | $39 | $44 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $9 | $17 | $26 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $12 | $39 | $65 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $33 | $49 | $68 |